THE A-Z OF MEDICAL WRITING

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THE A-Z OF MEDICAL WRITING

Tim Albert learnt the long words studying psychology and the short

ones as a Daily Mirror trainee He then worked for the broadsheets and the BBC and was education correspondent of the New Statesman.

Rampant hypochondriasis steered him into medical journalism, and

he was executive editor of World Medicine and editor of BMA News

Review Since 1990 he has run his own training company, delivering

hundreds of courses on writing to doctors and other health sionals He is a fellow of the Institute of Personnel and Development,

profes-organiser of the BMJ’s annual short course for journal editors, and

visiting fellow in medical writing at Southampton University

THE A-Z OF MEDICAL WRITING

Tim AlbertTim Albert Training, Surrey, UK

BMJ

Books

© BMJ Books 2000 BMJ Books is an imprint of the BMJ Publishing Group All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the

publishers.

First published in 2000

by BMJ Books, BMA House, Tavistock Square,

London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-7279-1487-1

Typeset by Saxon Graphics, Derby Printed and bound in Great Britain by J W Arrowsmith Ltd, Bristol

Contents

This book has not been written to be read – at least in the usual sense

of starting at the beginning, ploughing on to the end, and thenremembering (at best) one or two points I have written it for acompletely different purpose, which has come from my experiencesover the past 10 years working with doctors and other health profes-sionals to sort out a wide range of writing problems

It is clear that they face several difficulties when it comes towriting They are torn between the pressure to communicate withpatients on the one hand, and meet the expectations of their peers forhorrendously prolix prose on the other Although they will have had

no formal training on writing since they were 16, they will beexpected to publish in high status journals if they are to advance intheir careers Writing cultures have grown up that are, frankly,destructive of effective communication and individual talent And ofcourse, as trained doctors rather than trained writers, they have moreuseful things to do anyway

So this is not another reference book laying down rules ongrammar, style, or journalology, or the presentation of statistics orthe ethics of publication, even though I stray into these areas fromtime to time What this book sets out to do is to give support, encour-agement, and informed advice, so that people who have foundwriting hard will somehow find it less hard Acting on the experience

of training courses, I have chosen a large number of topics, which are

arranged alphabetically, from abbreviations to zzzzz.

Tim Albert

How to use this book

I expect this book to be used in two ways The first is as an fashioned companion, to be kept by a bedside or on a desk, so thatyou can dip into it during an otherwise idle moment and find the oddentry that will interest, amuse, stimulate or annoy The second is touse it for advice and encouragement when you have a specific writingproblem You have been asked to write an obituary, for instance, oryou are suffering from writer’s block In such cases, you should turn

old-to the specific entry, which in turn should guide you old-to other relatedentries, and in some cases to details of books that I have on my book-

shelf and find useful A word in bold type shows that there is another

section also of use

This book, as the title makes clear, is a personal choice, and I amsure that many topics could have been dealt with differently, and thatsome important ones have been left out altogether I hope that thisbook will evolve, and that we shall be able to make regular updates,both in the paper version and in electronic form To that end I hopethat readers will send me their comments, including suggestions fornew items to be covered in the next edition, and other pieces ofadvice and comment

Finally I would like to thank all those who have helped, in theirvarious ways, with this book These are Gordon Macpherson, HarveyMarcovitch, Pete Moore, Geoff Watts, Geert-Jan van Daal, DonRowntree, Margaret Hallendorff, Mary Banks and Michèle Clarke.The person who has suffered most for my art, as always, has been mywife Barbara, to whom I offer my special thanks

Tim AlbertDorkingtatraining@compuserve.com

ix

A–Z of Medical Writing

Abbreviations Modern science writing is written ingly in a kind of code, littered with phrases such as ‘a breakthrough

increas-in PE’ and ‘no laboratory monitorincreas-ing of APT’ Proponents argue thatthis is inevitable; it reflects the increasing specialization of medicineand saves valuable space for yet more papers

Opponents say that abbreviations mislead and confuse Oneperson’s British Medical Association will be another’s British MidlandAirways, or (as I once saw in a conference hotel in America) a BranchMarketing Assistant The initials CIA are identified so closely with USspies that it may be difficult to remember that they also stand forcommon iliac arteries The confusion intensifies when the abbrevia-tions disappear for a while, only to resurface after an absence of severalparagraphs when you have completely forgotten what they stand for.For this reason, and because they are in upper case, they slow thereader down They also send a strong message to the reader: this is ourlanguage, if you are uncomfortable with it, you don’t belong

Those who want to avoid abbreviations can usually do so, forinstance by spelling out in full one of the component words: ‘theassociation’, ‘the airline’ or ‘the assistant’ If you do insist on usingabbreviations, make sure that you spell out the words in full at theirfirst appearance, and try to use no more than two sets per document

(see acronyms; political writing).

Absolutes Many people use phrases such as ‘absoluteperfection’ and ‘completely exhausted’, where the first word is

redundant (though not ‘totally redundant’!) See also tautology.

Abstracts There are two types of abstracts There are thosethat stand on their own, as a means of securing an invitation to

present at a conference I call these conference abstracts and they

have an entry to themselves (see below).

The other type are those that appear at the start of a scientific paper,summarizing the information contained in that paper According to

the Vancouver Group, an abstract should state the purposes of the

study or investigation, basic procedures, main findings, and the cipal conclusions: ‘It should emphasize new and important aspects ofthe study or observation’ In some respects they are a marketing tool,

prin-ABBREVIATIONS

enabling potential readers to decide whether they should read thepaper in detail With the development of electronic databases, theynow have a role as a stand-alone unit of scientific knowledge.

Approach writing an abstract in the same way as you would

approach any other writing task (see process of writing) Don’t just

try to cut your article back to fit the space available, but treat this as aseparate piece of writing There are two pitfalls to avoid

• Ignoring the specifications Journals will make it absolutely clear in

the Instructions to Authors how they like their abstract to appear,

and it is senseless to ignore these requirements A modern trend isthe structured abstract, which has carefully defined sections tocomplete Study the instructions carefully, and look at abstracts inyour target journal One of the most commonly flouted require-ments is length: if they say 300 words they mean 300 words; anymore may be cut and your work could become meaningless

• Deviating from the original It is not hard to find examples of

submitted (and sometimes published) articles where details in theabstract simply do not appear in the article itself This danger isparticularly acute when the abstract has been written first By thetime the paper has been written and the co-authors have agreed,all kind of subtle changes have been made

Acceptance The supreme moment when something youhave written is accepted for publication Treasure it

Acknowledgements According to the Vancouver Group

these are the statements accompanying a scientific paper that ‘specify(a) contributions that do not justify authorship, such as generalsupport by a department chair, (b) acknowledgements of technicalhelp, (c) acknowledgements of financial and material support, whichshould specify the nature of the support; and (d) relationships thatmay pose a conflict of interest’ Naming people in this way assumesthat they endorse the contents, so you must have their writtenpermission Technical help should be acknowledged in a separate

paragraph Journals will vary in their approach to this (see

Instructions to Authors) The word can have a slightly different

meaning when it comes to books In such instances it is used to

acknowledge Copyright material.

2

Acronyms These are abbreviations that can be pronounced

as a word, and are currently the fashionable way to describe (andmarket) a piece of science – the ARIC study, the HOT trial or justplain MONICA The number is exploding, so if you want to use one,make sure it has not already been taken

Many newspapers and magazines adopt the style that, if you canpronounce an acronym, you write it with one initial capital only.Thus UN but Unesco This explains why, although AIDS seems to bethe preferred style in medical journals, most other publications style

it Aids Both are right, within their contexts (see style guides).

Action lists These are beginning to take over from the more

traditional minutes as the preferred way of recording the activities of

a committee They are based on the principle that recording the sions is fairly straightforward; the hard thing is ensuring that they

deci-are carried out To produce an action list, write down in clear active

language, what has to be done, by whom, and by when Review at thestart of each meeting

Active The basic way of writing a sentence, in which someone

or something does something to someone or something else Thus:

‘Dr Smith wrote the article’ and ‘The article changed the world’ Theplace of the active in science writing is confused and controversial

(see verbs; voice).

Adjectives Describing words, such as ‘old’, ‘busy’ We overusethem dreadfully: ‘When you catch an adjective, kill it’, said MarkTwain Say exactly how old (‘41 years and a day’), or how we can tell thatthe person was busy (‘Between lunch and tea she chaired threemeetings, ran four miles on the treadmill, and attended a bar mitzvah’)

Adverbs The words that modify a verb (or ‘doing’ word), such

as ‘slowly’, ‘quickly’ Again, these can be overused Prefer nouns and

verbs: ‘He took four hours to answer the question.’

Advertising Written material that promotes the interests of

whoever paid for it Distinguish from editorial.

ACRONYMS

Advertorial Articles that look like objective text, but are infact paid for by an advertiser They appear more frequently insmaller, local publications, and can usually be recognized by the

large number of favourable adjectives: ‘elegant surroundings’,

‘friendly staff ’, ‘mouthwatering desserts’ Editors should make itclear that these are advertising features but, alas, do not always do so

Advice on writing You will have little difficulty findingpeople to comment on what you have written The problem isknowing when their advice is useful – or ill-informed and dangerous.Beware those who base their comments on their own views on ‘good

writing’ without finding out how you have defined your audience

and what you want your writing to achieve (see false feedback loop).

Good advisers will first ask for details of your target audience They

will also give you balanced feedback.

Agents One of the most common questions that would-bewriters ask is: ‘Should I get an agent?’ The best answer is to turn itround: ‘Should an agent spend time on you?’ What do you offer thatwill give enough income for two to share?

If you believe that you are about to make huge amounts of moneyfrom your writing and want some help in getting the best deal, thereare two main ways of finding an agent The first is to get a reference

book (see below), look up the names of some agents, and identify one

or two that sound suitable This process is unlikely to be scientific.You will then have to send in some kind of proposal Your chances ofbeing accepted by the first agent, or even any agent, are slight Analternative technique is to find and bedazzle one at a party: thismeans joining the kind of group where these people are likely tocongregate, such as the Society of Authors

Meanwhile, don’t give up the day job

BOOKLIST: agents

• Writers’ and artists’ yearbook, London: A&C Black, 1999 First

published in the first decade of the 20th century, this has nearly

700 pages packed with names, addresses and other mation, plus useful articles on a range of topics from copyright

infor-to research and the Internet

4

• The writer’s handbook, edited by Barry Turner, London:

Macmillan 1999 A more recent guide, with 750 pages packedwith similar information All this and a foreword from PD James

American English This can give problems (see UK–US

English).

Amongst A curiously old-fashioned word What’s wrongwith ‘among’?

Analytical skills These are at the heart of good writing

Unless you have a clear idea of the message you wish to put across,

you are merely collecting data and shuffling it around (see leaf

shuf-fling; process of writing).

And You are allowed to start a sentence with this word (andwith ‘But’) And those who tell you otherwise are ill-informed But ifthey don’t believe you, invite them to look in any contemporary

reference work (see grammar booklist).

Annual report of public health Public health ments have to publish an annual report Unfortunately nobodyreally made it clear why and – more importantly – for whom Whilethe best reports give clear, considered messages to specified audi-ences – such as professional colleagues, local politicians, or the

depart-Guardian-reading public – many fall uncomfortably between a

number of audiences, pleasing none and costing a fair amount ofmoney and aggravation

This confusion has a clear implication Directors of public health

must clearly assume, or assign to another, the role of editor for their

annual report This means defining and communicating the report’s

mission and primary audience, which will enable their colleagues to

write their chapters effectively, using last year’s report as a model (see

evidence-based writing) This in turn should free everybody to get

on with some of the better defined tasks in public health

AGENTS

Antipathy The feeling that readers have for pieces of writing

that are over-long, over-researched, and over-written (see PIANO).

Apathy A frequent cry among editors is: ‘No one will bother

writing for me!’ Why should they (see commissioning)?

Apostrophes Rarely does the wrong use of the apostrophechange the meaning of a sentence But it is an error that some peopleseize upon with glee, inferring that whoever made it must be ill-educated, incompetent and therefore can be ignored Writers shouldmake every effort to get it right; it’s not particularly difficult becauseits solution is at hand

When it comes to the difference between ‘its’ and ‘it’s’, forget aboutlearning about possessives and so on (if you don’t know now youprobably never will) Simply consider the apostrophe as the top of an

‘i’ Thus ‘it’s colour’ really means ‘it is colour’ (‘It is colour that makesthe difference’ as opposed to ‘Its colour is red’) This should help you

to get it right If you still don’t understand, ask people who know

about these things to check them for you (see grammar booklist).

Appendix Additional material that comes at the end of areport, but is an optional extra: a useful device because it offersreaders the opportunity to see the evidence without having to ploughthrough it all

Article A piece of writing that is published There are two

types: those published in magazines and newspapers (see feature

article), or those published in journals (see scientific paper).

Confuse the two at your peril See also review articles; short articles.

Audience The person or persons for whom you are writing.The chances of your work being read increase dramatically if youfollow the following two principles

• Define the audience tightly When writing a letter, you can target the

recipient When writing a report, you can target the decisionmaker When writing for a publication, you can target the editor.6

• Separate distinct audiences It becomes much harder to make a piece

of writing work when you have to balance the needs of distinctaudiences, such as a panel of doctors and a group of patients Ifyou have two audiences, do two pieces of writing The timeneeded to write the second version will be far less than you fear,but the chances of getting the message across will increase signifi-cantly

This is probably one of the great principles of effective writing If youhave a clear idea of your readers, you can research what style and

structure works for them (see evidence based writing).

Author’s editors A few academic departments throughout

the world employ professional technical editors to help doctors and

scientists to prepare a paper for publication Although there are someexcellent practitioners, the system has failed to take off

One of the main reasons is that employing someone who knowsabout writing is helpful only if those who employ them are equally asinformed Often good advice from the author’s editor is over-ruled,wasting time and money And if a paper is turned down, it’s theauthor’s editor, not the author, who tends to get the blame

Authorship Over the past few years the question ofauthorship – whether someone has his or her name attached as a ‘partowner’ of a scientific paper – has become a hot issue This is becausethe way editors tend to define it is at odds with the way it is defined

by the authors themselves

Editors are vehemently opposed to the practice of listing people

as co-authors when they have contributed little or nothing (gift

authorship) The Vancouver Group clearly states that each author

‘should have participated sufficiently in the work to take publicresponsibility for the content Authorship credit should be basedonly on substantial contributions Participation solely in theacquisition of funding or the collection of data does not justifyauthorship.’

Things look different from the author’s point of view, and theseprinciples are of little help to junior doctors, who are not in aposition to argue when seniors demand to be included on the list ofauthors Usually they have no choice but to add the name, eventhough the new ‘author’ contributed little or nothing One usefultechnique is to agree on the number and role of the co-authors before

AUDIENCE

the article is written (see brief setting) This should limit the practice

of people jumping aboard once all the work has been done

The real cause of the trouble is the fact that authorship is now one

of the main international performance indicators for scientists and,less obviously, for doctors There is no reason to believe that theability to publish in an English language journal should predict theclinical performance of a Dutch doctor, but that is currently a fact oflife, and until the system is reformed conflicts will exist betweenthose who want some easy points (and perhaps get back to theirproper jobs) and editors who feel that this is somehow not playingthe game

Meanwhile, the current trend is for journals to add lists explainingwho did what If this is the style of your target journal, then follow it

(see evidence-based writing) See also ghost author.

Autobiography Great to do; don’t expect others to be

inter-ested (see vanity publishing).

Bad writing I take a pragmatic view and define bad writing aswriting that fails to get the desired message across to the target

audience (see brief setting) Four types of errors may get in the way.

• It’s wrong The writing may read easily and appear plausible but,

alas, the arguments depend on facts that appear to be, or later turn

out to be, not true (see scientific fraud) There is absolutely no

defence for this

• The language is inappropriate The author has chosen words and

constructions with which the audience is not familiar (see jargon).

This can be fixed relatively easily, if the will is there

• It is difficult to follow the argument The sentences don’t seem to

follow on from one another, so that readers find it difficult to

understand what is going on (see structure; yellow marker test).

This can be fixed by altering sentences and paragraphs, though ittakes considerable time and is difficult to do well

• It leaves the reader wondering why it was written at all These are

those pieces of writing that you gamely wade through, but by the8

end have no idea why (see brief setting; message) If the writer

cannot define a clear message, then the reader will be unable to,and the writing will be doomed to fail

Balanced feedback When people ask us to comment on

their writing, we tend to shower them with criticism (see correcting

the work of others) Balanced feedback is a simple technique that

allows us to improve the writing without wrecking the writer’smorale

Whenever you are asked your opinion on a piece of writing, first

establish the audience for which is intended Read the piece quickly,

after which you will be in a position to make up your mind on thefollowing key questions

• What is the message and is it right for the target audience? Is the

message in an appropriate place (look in particular at the first andlast sentences) Is it a reasonable message? And is it appropriatefor the audience?

• Is the writing structured in an appropriate way? Did the writing keep

your interest or did you find yourself flagging? Were there placeswhere you had to go back and start again?

• Is the tone appropriate? Ask whether the style is, broadly speaking,

appropriate, but don’t worry too much at this stage about

indi-vidual points of style Here the various readability tests will

come in useful

These are macro-editing issues, and you should be able to find at

least one area where the writer has done well Write a short note,drawing attention to what you think is already good – and what youthink the writer needs to work on For example: ‘You have a clearmessage, which is interesting and well worth putting across to yourtarget readers You have written it in an appropriate tone Theargument became a little difficult to follow between the fifth andeighth paragraphs – and you may wish to insert some key sentences

so that the reader can see why you have included this information.’

If you still wish to deface the text with detailed changes

(micro-editing) you can now do so You will have put them in context as

fairly minor amendments (or nit-picking stuff) Even under these

circumstances I would urge restraint: would it really make a difference if you didn’t have your way over style every time? (see

macro-editing; micro-editing).

BAD WRITING

Biorhythms If you need to do a lot of writing, work out thebest times of the day for you in which to write If possible, arrangeyour schedule so that you can write during these periods: yourwriting is unlikely to be fresh and attractive if you are fighting anoverwhelming desire to take a nap.

Block See writer’s block.

Blurb A piece of writing that puffs itself or praises another, as

on the outside of this book cover (I hope) Science journals ingly carry blurbs (or short summaries of interesting articles) on anearly editorial page The purpose of these is to whip up interest andentice readers to keep turning the pages

increas-Booklists A kind of fashion accessory, without which itappears no self-respecting book should be published I suspect thatfew people make much use of them This book does not have abooklist at the back Instead I have chosen one or two books from mybookshelf and will recommend them at the appropriate point Under

grammar, for instance, there will be a short selection of books, for

reading and reference

Books, buying of To be encouraged, though sadly theknowledge in them is not transferred unless they are actually read

Book reviews Follow the same principles as for review

articles, but keep them shorter

Books, editing of In a fast-changing world, where oneperson will find it difficult to keep in touch with all the develop-

ments in even a narrow specialty, there is a good case for

multi-authored books But someone has to edit them Those chosen may

not have to spend hours researching topics just below the horizons oftheir immediate knowledge, but they will have a host of otherproblems Here are some tips

10

• Be absolutely clear that you want to do the book Editing takes up huge

amounts of time, and will eat into the rest of your life It is tering to be asked to edit a book, but what’s in it for you? Andwhat can you give up to make the time?

flat-• Establish good relations with the publishers Before you invest your

time, make sure that you have a clear proposal from the publisher,and that you are happy with it You may wish to take advice from alawyer or (if you are a member) from a group such as the Society ofAuthors Issues to clarify include the nature of rewards for youand your contributors, the amount of practical support (e.g letters

to contributors) that the publishers will provide, and (particularlyimportant these days) electronic rights Do not over-negotiate.Establishing a good relationship with the commissioning editor

at this stage will pay off later Consider lunch

• Make explicit plans Work out what topics you will need to cover,

and decide who you want to cover them Don’t rely on your ownnetwork: literature searches will enable you to locate acknow-ledged experts Work out a timetable, allowing plenty of slack forslow writers Have a fallback plan – for instance another authorstanding by – for the inevitable authors who fail to deliver

• Brief the contributors Make sure everyone knows exactly what you

want them to do, in what form and by when Write down clearly

what you want them to achieve (see brief setting) Make sure they

know what the other contributors are covering and who the

audience will be Give clear deadlines Make sure everything is in

writing (see commissioning).

• Support the contributors Many editors feel that once they have

briefed their contributors, all they need to do is to pen an elegantintroduction This is an illusion You should build in somesupport for your writers, such as a telephone call, otherwise thechances are you will reach the final deadline with no copy

submitted (see apathy).

• Collect the chapters and do some macro-editing Publishers will want

their own technical editors to have an input, but there is still animportant role for the editor in reading the submissions, makingsure that they meet the intended purpose and standard, andsorting them out so that they do Keep an eye out for unfair crit-

icism of the work of rivals (see defamation); you may need to dig

deep into your reserves of tact and diplomacy

• Thank the contributors Most will have spent time and effort on your

behalf, so it is common courtesy to thank them as soon as theysend in their chapter, with a follow-up letter and a copy of the

BOOKS, EDITING OF

book once it is published Apart from anything else, if you decide

to do another book, you will need some good and loyal writers

At the end many editors feel that they have written it all themselves.Sometimes they have

Books, writing of There are many good reasons why youshould under no circumstances write a book It eats time (as a roughguide equivalent to three months of a full-time job) It is difficult tofind a publisher It is a painful activity, during which writers becomedeeply antisocial The financial rewards are usually low, and out ofproportion to the work involved

If, after reading this, you still want to continue, then you probablyshould The first thing to do is to have an idea Then ask the keyquestion: will enough people be interested enough to spend money

on buying it? If you still wish to keep going, follow these stages

• Identify a suitable publisher Go to a bookshop or use the Internet to

browse, then construct a proposal, and send it in Publishers areinterested in good ideas, and want evidence that you are likely to

do it well Start with a brief description (200 words or so) of whatyou intend to do and who will buy the book Include a list ofchapter headings (for non-fiction) or a sample chapter (if fiction)

You will also need a covering letter, giving perhaps one or two

reasons why you think you should be trusted (author of 17 otherbooks, professor of book writing, UN expert on pagination, etc).Finally, add supporting information, such as articles you may

have written, or a CV Send everything off, keeping a copy in the

drawer Now try to obliterate any trace of it from your memoryuntil you receive the reply

• Gain from the pain Most people fail at the first attempt, so learn

from rejection Even if you think the publisher has made a

dreadful mistake (and it does happen: George Orwell’s

manu-script for Animal farm was rejected on the grounds that it is

‘impossible to sell animal stories in the USA’), consider whetheryou could and should make changes

• Accept your first contract graciously Your contract will almost

certainly offer substantially less than you think you are worth.You may wish to consult a lawyer or the Society of Authors; alter-natively you may wish to take the view that publishers are doingthis all the time, and as a newcomer and first-time author it will beunwise to rock the boat (After the extraordinary success of yourfirst book, however, you can afford to take a more muscular line,12

employ an agent and screw the publishers into the ground, if that

is your style

• Sit down and plan Work out when you have to submit the

manu-script and put the key dates in your diary Work back: allow timefor rewriting Also allow time for other people to look at themanuscript, and for doing the tricky administrative things like

seeking copyright Then put down some deadlines for the actual

writing: how many of your 50 000 words do you intend to write amonth? And, more importantly, when? How will you find time –

do you plan to give up your evenings at the gym, or your

mornings in bed, or your weekends in the garden? (see time

management).

• Keep in touch with your editor It helps if your editor still has

positive feelings towards you when you send in your manuscript.Don’t be afraid to ask for advice: it is better to sort out problemsearly rather than haggle over them at the last minute

• Find out how your publisher would like the copy to be presented.

Most publishers like a ‘clean’ disk (i.e simple text withoutdesigned tables and boxes; italics and bold are normally trans-

lated easily into other systems), so that their own copy-editors

or designers can do the formatting (or ‘marking up’) selves But this does not necessarily mean that you have to write

them-it that way If, like me, you are one of those people who need to

fiddle with the way your writing actually looks (see layout), feel

free to do so

• When you finally send the manuscript off, expect changes Your

publisher will have been involved in many more books thanyou have and will be better attuned to the target audience Thisdoesn’t mean to say that copy editors are infallible, but if you dodisagree, do so with tact, charm and, above all, evidence and areasoned argument (evidence-based complaining?) If youthink every proposed change is an insult to your great talent,you are either being unrealistic or are with the wrongpublisher You then have a simple decision to take: do younegotiate, or do you end the relationship and try to find anotherpublisher?

• Enjoy the publication After about six months the book will be

published – and there will probably be an anticlimax Do all youcan to help during the marketing phase

Now is the time to await the plaudits and the cheques Both will offermeagre fare Your friends will say (to your face) that the book iswonderful (and then drop hints about a free signed copy); letters of

BOOKS, WRITING OF

praise from unknown admirers are less likely As for the money, youwill probably have signed a contract for 12.5% net of the royalties.With a print run of, say, 2000 at a price of £12.50, that will give youabout £1500 (less tax) if all copies are sold Hardly a good return onthe huge effort you made.

The real point about writing books is that, like mountains, theyare there Some of us cannot resist the challenge; but it’s hardlyrational behaviour

Books, writing of chapters in One of the great tages of multi-authored books is that they meet the huge demand forauthorship But even single chapters require a major investment oftime – a week’s work or more to do it properly Be flattered by theinvitation to contribute, and then consider whether you really want(or need) to invest the time Saying no at this stage will be appre-ciated: publishers say that their biggest problem in multi-authoredbooks is dealing with the delays caused by those who keep insistingthat they want to contribute, but never get around to doing so

advan-Approach the project as you would any other writing task (see

process of writing) Divide the chapter into manageable chunks of

1000 words or so, and use the structure of a feature article for each

section

Your main reward will be satisfaction of a job well done You areunlikely to get paid, and if so it will rarely be above £200 a chapter.You should be offered a free copy of the book; make sure you display

it prominently

Boredom We often experience this when reading what othershave written Curiously, we never expect our readers to do so whenreading our work

Borrowing other people’s ideas This is stealing Do not

do it (see copyright; plagiarism).

Bosses Some are marvellously helpful when it comes to

giving balanced feedback on what we write Others are

discour-aging, and sometimes dangerous Remember that bosses can turn

into a powerful false feedback loop, and that throughout the writing

14

process our duty is to argue – tactfully – for the interests of our target

readers (see negotiating over copy).

Brainstorming Throughout the writing process ourtendency to criticize can overwhelm our capacity to be creative.Brainstorming techniques try to circumvent that in the planningstage by encouraging us to put down our thoughts on paper – as theycome and without stopping to criticize them At its basic level we can

use this method to compile a list A development of this is branching

(see below) where we allow our thoughts to spill out all over the page

in a much freer way A sophisticated version of this is mindmapping,

a system developed by Tony Buzan (see process of writing booklist).

Branching Branching techniques, such as spidercharts and

mindmapping, play an important part in the writing process – in

particular, at the stage when you have decided on your message and

need to collect and arrange the information needed to prove it All you need is the message, a large piece of paper with at least onepen or pencil (some say more) and 5–10 minutes Write the message

in the middle of the paper (‘All writers should buy a treadmill’) andthen start asking questions (‘What kind of writers?’, ‘What kind oftreadmill?’, ‘How should writers use it?’ ‘How do we know it helps?’and so on) Each question should lead to others, and when you come

to the end of one train of thought you should go back to the message

in the middle and start again Within minutes you will have a pagecovered with words, all coming out from the message in the middle.The advantage of this, as one course participant once put it, is thatthe mess in your head is now the mess on a piece of paper This is abreakthrough Committing yourself to putting things down on paper

is one of the hardest parts of writing (see writer’s block), but as soon

as you have something down you can start to control it You will, forinstance, be able to distinguish between matters of substance that

must be included, and detail that could be included if space permits.

All will be related to the message

Breaks Locking yourself in a room for three hours at a time isunlikely to boost your creativity Try to write in short bursts of, say,10–15 minutes, and make sure that you really are writing and not

worrying about what you have just written (see free writing).

BOSSES

Nothing benefits a piece of writing more than the temporary leaving

of it See also time management.

Brief setting One of the great mistakes we make whenwriting is to start too early, without really knowing where we want toend up Some people start by writing lists; others go straight to aword processor and start writing down what comes into their heads

I recommend an alternative step, originally recommended in Medical

journalism; the writer’s guide (see Journalism booklist), in which I

advise that the first thing to do is to draw back from writing – and tothink very carefully about what you want to do By all means let yourwriting be a voyage of discovery, but look at the existing navigationcharts before you set out

I call this stage ‘setting the brief ’ It involves taking time to thinkabout what you want to do You may be able to do it in less than aminute; with more difficult pieces of writing you may need days or

even weeks As long as it remains rumination, not procrastination,

you should not worry As for what you need to think about, these arecontained in the following five points

• Message Work out the most important thing you want your

readers to take away from your writing This is the message, and

should take the form of a simple sentence of about 10 words Forinstance: ‘Wearing sandals with socks reduces the incidence ofathlete’s foot.’ The key is to include a verb (‘reduces’, ‘increases’,

‘does not affect’, etc.) which gives it direction It will also

distin-guish it from a title, which (in journals) usually consists of a string

of nouns (‘Footwear apparel and fungal infections of the skin andnails of the feet: a randomized placebo-controlled trial’) that willnot make a suitable starting point Do not settle for a question: ifyou do not yet have the answer, do more research or morethinking or both

• Market Decide for whom this message is intended (audience) and

how you intend to get it to them Be specific: the more tightlydefined your audience, the greater your chances of success If you

want to write an article, define which journal (The Lancet, for instance, or Country Life?) If you are writing a report justifying

the purchase of an expensive piece of equipment, write for themain player in the decision-making committee If you are writing

a procedure for a new clinic’s appointment system, write for thosewho will have to carry it out If it looks as though you will have toplease two separate audiences at the same time – such as a report16

on the latest research for members of a patient group and ested doctors – then write two different reports.

inter-• Length and other aspects of style Now work out what you need to

please your audience Decide on the length of the piece of writing,

measured in words or paragraphs This should not be determined

by how you rate the importance of the topic (or happen to knowabout it), but on what the market should bear

• Deadlines Set the date by which you need to finish the writing.

Then work backwards, inserting second-level deadlines for the

major steps you need to take on the way

• Payoff Define how you will judge the success of your writing Too

often we judge it in terms of half-remembered notions of literary

criticism (see English teachers; examinations) Now we are

established in our careers, we should regard writing as a tool not atest, and therefore judge success not by the details, but by whetherour writing has enabled us to achieve what we set out to do Forinstance, if we are trying to attract a £1 million grant, and wemanage to do so, our writing has succeeded, irrespective ofwhether we have split the odd infinitive Similarly, if we are trying

to get a paper published in a prestigious journal and it is accepted,

we have also succeeded (and subsequent gripes from rivals should

be seen in this context)

Take your time over brief setting You may not believe it at the time,but having a clear idea on the above five questions will make all thedifference to what you are setting out to do Consider the followingexamples, both on the subject of socks, shoes and athlete’s foot:

• Task 1 ‘A research letter for The Lancet showing that sandals and

socks reduce the incidence of athlete’s foot This will be based onthe multicentre SOLE trial and will comprise 500 words Thearticle will be written by August 1, revised by August 15, sent out

to co-authors on September 1 and submitted on September 21.The writing will be considered successful when the editor accepts

it for publication.’

• Task 2 ‘A report for the management board arguing that sandals

and socks should be issued to all staff in order to reduce the dence of athlete’s foot The primary audience will be the director

inci-of human resources The report will consist inci-of one sheet inci-of A4.The first draft will be completed tomorrow, and revised thefollowing day The writing will be considered successful whenstaff get issued with their regulation socks and sandals.’

A useful trick is to make sure that others, such as bosses or

co-authors, who may subsequently want to comment on your piece of

BRIEF SETTING

writing, see these details before you start Don’t wait for the finishedpiece; show them the brief Agreeing on the message and the market

at this early stage can save endless arguments later on (see

negoti-ating over copy).

Bullet points Bullet points are currently fashionable Theyare useful when:

• you have a small number of discrete facts, all of which are roughly

as important as the others, and

• you expect your reader to be skimming what you have written They become less useful when you want to persuade or lead yourreaders through a complicated argument, or perhaps feel that yourreader could do with a little entertainment

There is a trap when it comes to punctuating bullet point lists.Strictly speaking the bullet is not a punctuation mark, so you shouldignore it A list should therefore start with a colon like this:

• not followed by a capital letter and not ending in a full stop but in

a comma or semicolon,

• until you get to the last point

Byline The name of an author on an article in a newspaper or

magazine Getting one of these can be a major incentive (see

commis-sioning).

Capital letters These should be used for signalling thebeginning of a sentence, or of a proper noun such as Aylesbury orZimmerman They need no longer be used for seasons, though they

are still used for months and days of the week Do not use them on the

grounds that they make the word look more important (see pompous

initial capitals).

18

Careers in writing A number of jobs combine a knowledge

of medical matters with an interest in writing These include

working as an associate editor on a scientific journal, working as a writer on a medical newspaper or producing marketing material for

pharmaceutical companies It is tempting to look at these as anescape route from the demands of patients and colleagues, andindeed working as a writer has a number of good points Writingprofessionals tend to be less hierarchical, and the hours tend to bemore civilized You can see what you produce, and can measure your

performance (see effective writing)

But being a doctor will not in itself qualify you to write aboutmedicine, and you will need to acquire some extra skills This couldmean a full-time course for a year, or it could mean a period ofapprenticeship within medical writing The levels of pay are likely to

be less than one would expect as a doctor For further informationcontact doctors who are already working in these fields

Case notes Doctors are writing these all the time, yet they aredifficult to do – and are often done badly Tell the story, so that oneweek later (the next doctor) or five years later (the lawyers) will beable to reconstruct exactly what happened Tell the truth, and writeclearly

Case reports In the past these were a good way to get yourname on the databases Unfortunately the current trend for largerand larger statistical samples means that they are currently out offavour among editors, and the demand for case reports is much lessthan the supply You now have to look around carefully for a journal

that will take them When you find one, use the yellow marker test

to study the structure, which will vary from journal to journal Thinkcarefully about whether you have a suitable case – look in particularfor a good message that will have immediate clinical relevance, such

as the patient whose rash on the inside leg turned out to be a rare case

of hepatitis M Then approach this as you would approach any

written work (see process of writing).

Chapters, writing of See books, writing of chapters in

CAREERS IN WRITING

Checking facts This is important Often it makes littlesubstantive difference to the main thesis (Mr William Browne willhave been sacked from his prestigious post regardless of the fact thatyou have left the ‘e’ off his name and have called him Mr Brown), butthose who know will lose confidence in the rest of your writing – andgleefully tell others of your shortcomings On the other hand, thenature of writing is such is that it is almost impossible to achieve100% accuracy So pay particular attention to things that matter:dosages, for instance, or names and titles And don’t become suicidal

when the occasional error creeps in (see law of late literals).

Checklists All kinds of people, from publishers to gists, produce checklists to use when writing papers and reviews Theseare useful up to a point (or first 80 points!) But obsession with detail

methodolo-can obscure, or drive out, sensible messages Good writing is not just a

succession of facts put down in a plausible order (see leaf shuffling), but

an interesting or important message, supported by evidence (see truth).

Christian names This term is inappropriate in today’smulticultural societies Use ‘first names’

Citation index See impact factor.

Clichés The word comes from the French term for a printingblock, and means a phrase that is reproduced so often that it is at bestunoriginal, at worst tiresome Clichés make splendid targets: forinstance ‘the focus on a fundamental shift in the culture of learning,leading to empowerment and a win-win situation’ However, somephrases, like ‘ownership’ and ‘mission statement’, have their own

technical use among certain groups (see jargon) And some, like

‘moving the goal posts’ and ‘gold standard’ are a kind of shorthandthat allow us to put across a familiar idea quickly and easily

So what should the writer do? First, avoid choosing clichés that

will cause your target reader (though not your false feedback loop)

to ridicule you Second, if you see a familiar phrase, ask yourselfwhether something more original would be a better choice Don’tfeel you must get rid of them all: I have deliberately used severalthroughout this book But don’t over-egg the pudding

20

Coaching. All too often people who write find that their only

‘reward’ is a mass of minor textual criticism This is not normallyconsidered the best way to develop and motivate people Coaching is

an alternative approach, based on the assumption that people do best

at a task if they are allowed to get on with it themselves Those withmore writing experience should resist the temptation to give a mass

of ‘corrections’, and instead offer support and encouragement This

approach is not necessarily taught in medical school

Coaching can be of value at four different phases

• Strategy Many people feel that they should be writing (scientific

papers, for instance) but aren’t quite sure how Encourage them to

sit down and work out why they need to write In the light of this,

get them to commit to the what and the when (see writing goals).

• Tactics Too many people launch themselves too quickly into a

piece of writing Encourage them to take time to ruminate, to set their own brief – and provide support at this early stage Don’t

criticize, but probe with open-ended questions so that writers candevelop their own ideas Look for whether the writer has clearlydefined the audience Question how the writer will judge success

(see payoff) Encourage research on the market as well as the topic being written about (see evidence-based writing) Set deadlines.

• Execution Once the writing process has started, provide support

and encouragement Meet regularly to ensure that the deadlinesare being met and, if not, work with the writer to find ways of

getting the work moving again Encourage writers’ support

groups When (and if) the time comes for you to look at the

manu-script, ask why you are being asked to read it – for silly mistakes,for instance, for major factual omissions or for potential political

problems? Give balanced feedback And give priority to keeping

the copy moving: nothing demotivates more than to have worksitting in someone else’s pending tray

• Reward Follow the example of successful sports coaches – and

celebrate whenever you achieve your goals Create a culture wherewinning – as defined by the writer in advance – is celebrated

BOOKLIST: coaching

• The coaching pocketbook, by Ian Fleming and Allan JD Taylor,

Alresford: Management Pocketbooks, 1998 Entertaining andversatile, part of an excellent series that also includes books ontime management and personal development

• Writing your dissertation in 15 minutes a day, by Joan Bolker,

New York: Henry Holt, 1998 Ostensibly for those who are setting

COACHING

out to write a thesis, this is perhaps even more useful for visors Some interesting thoughts on setting up writers’ groups.

super-• Coaching writers: the essential guide for editors and reports, by

Roy Peter Clark and Don Fry, New York: St Martin’s Press,

1992 An interesting book from two journalists in Florida withimportant lessons for those working with writers

Co-authors As a general rule, the greater the number of authors, the greater the problems The manuscript over which youhave been sweating for months is torn apart by others, who believethat they are failing if they are not pumping out as many criticisms asthey can think of The poor author is then left, manuscript and confi-dence in tatters, with a pile of alternative suggestions, many of themconflicting

co-You will be pleased to know that there are some techniques thatcan ease the pain

• Arrange a meeting at the beginning of the writing process Agree who

the co-authors will be, what they will do, and in which order they

will appear on the manuscript (see authorship) Lay down

dead-lines, agree on the target journal and, more important still, get

everyone to agree what the message will be (see brief setting).

• Circulate the timetable among the co-authors Some people will always

sit on a manuscript If all co-authors have agreed on the deadlines,you have a lever which may help to move the laggards Send co-authors regular updates of progress; this will enable everyone toidentify those who are slowing the process down Sometimes a bit

of naming and shaming will help

• Involve your co-authors throughout the process Co-authors need to

have a ‘substantial intellectual involvement’, but this does notnecessarily mean detailed textual criticism once the work hasbeen done Far more important is the support and advice received

as you are preparing the various drafts, and this is really the timeyou need sensible input from your colleagues Keep them in touchwith what you are doing, and encourage them to play the role of

coach rather than critic.

• Judge any comment from a co-author on whether it is more – or less –

likely to get your paper published in your target journal One of the

major problems at this stage is the mass of conflicting advice aseach co-author proposes amendments on his or her notion of what

makes a ‘good’ paper (see Icarus fallacy) The sensible way

through this is to judge these comments on whether they are more22

– or less – likely to increase the chances of publication (see

evidence-based writing) Discuss those that are clearly counter

productive (see negotiating changes).

• Try to steer your co-authors into doing what you want them to do.

Instead of saying ‘Please let me have your comments’, which is anopen invitation to be destructive, try, ‘I enclose the draft of this

article which, as you know, has been targeted at The Lancet Can

you let me know if you see any major omissions?’ (If you have

been keeping people involved (see above), then perhaps you can

try: ‘Can I assume that you are now happy for me to send it off?’)

• Don’t take it personally Being criticized seems to be part of the

publications game Don’t be demoralized Keep remindingyourself that you are making progress and that this is one of thelast major obstacles

• Do not be bullied into doing what you think is wrong Under no

circumstances should you give in to pressure from co-authors to

do anything that you think is morally wrong, such as make uppatients who did not exist, or ‘massage’ the figures to make the

work look better (see scientific fraud) This can be easier said than

done, and if you are unlucky enough to be involved in such a ation, seek a wise head for immediate confidential advice

situ-If you survive your relationship with your co-authors, and youbecome published authors, celebrate It will make all the aggravationand humiliation seem worthwhile – until the next time

Colon A punctuation mark that denotes a major pause thatcomes before an explanation or elaboration, as in, ‘I am telling yousomething important in this section: it is how to use the colon appro-priately’

In US English usage it is common to have a capital letter after thecolon (‘He wanted three things: To visit every hospital in

Poughkeepsie, write a book review for the New Yorker, and learn how

to use chopsticks’) This is not the case in UK English, though your

word processing package may not know this (see semicolon; UK-US

English)

Colon dash(as in :-) These are archaic, ugly and should not

be used

CO-AUTHORS

Commas A punctuation mark that indicates a slight pause: ‘Hecame and went’ is different from ‘he came, and went’ Commas areimportant, and can cause all kinds of howlers when omitted or wronglyplaced, as in: ‘The society is made up of those who experience diffi-culties in digestion of their relatives, and of other interested people’.One of the big problems occurs when commas are used to make aseparate and self-contained point, in which case they should alwaystravel in pairs ‘The patients, who had demanded compensationrushed to their lawyers’ is ambiguous Does it mean that a group whohad demanded compensation went to their lawyers while anothergroup stayed put (‘The patients who had demanded compensationrushed to their lawyers’)? Or does it mean that a group of patientshad rushed to their lawyers and all of them were demanding compen-sation (‘The patients, who had demanded compensation, rushed totheir lawyers)?

The use of commas in lists can cause confusion This is because in

UK English the comma is dropped before the ‘and’ (‘stethoscopes,

zebras and chairs’) This does not happen in US English

(‘stetho-scopes, zebras, and chairs’)

There is a fashion, particularly among medical journals, to beparsimonious with the comma This can cause difficulties for the

reader (see grammar booklist).

Commissioning The success of most publications leansheavily on the quality of its contributors, so the ability to persuade

good writers to contribute is an important skill (see books, editing

of) Having an idea for an article is relatively easy; the hard thing is

to find someone who will do it well (better than you, otherwise whybother?) Hardest of all is getting that person motivated

Commissioning editors usually make the first contact by phone Ifyou are commissioning, have a clear idea of what you want: it is nothelpful to give a long list of points that you wish the writer toinclude; instead describe what you want the article to achieve Alsodiscuss deadline, technical points (such as whether you want thearticle to be sent by e-mail) and payment or other reward

Once you have agreement, write a follow-up letter, which shouldcover the following questions

• What kind of publication is it? The writer should be clear about the

goals of the publication – and about its audience If you think thewriter is unfamiliar with the publication, send one or two backcopies

24

• Where in the publication will it go? Knowing exactly where it will go

will help the writer to do such basic things as write to length andensure the right tone

• What do you want the article to do? The writer needs a clear

confir-mation of the subject matter and broad intent, so that he or she

can start to work out an appropriate message (see brief setting).

• When do you need the copy? You should have agreed this verbally,

and it should be realistic for both of you Make sure that it isn’t sotight that failure to meet it will leave you in a completely imposs-ible position

• How much you will pay (or any other reward)? Nobody does anything

for nothing so what will be in it for the writer? Spell out thereward in your letter

• Who will own the copyright? This is a controversial issue nowadays

and some editors may feel safer leaving this out and hoping for the

best (see copyright).

If you have done your job, by the time the deadline comes you willhave exactly what you want – or better Now should come afrequently neglected step Writers spend long and lonely hours, andusually crave reassurance it has been worthwhile Many articlesdisappear into black holes, with authors getting feedback only whensomeone tells them they have seen the article in print.Commissioning editors, therefore, should always say thank you, byphone, e-mail, letter or in person

If you decide that the article is not what you want, you can ask thewriter to try again (in which case you have to be specific about theexact things he or she needs to do) Alternatively you can reject it, inwhich case you have a duty to return it as quickly as possible to the

author, who may wish to submit it elsewhere (see rejection) You

have a duty to be polite when rejecting an article, but you do nothave to justify yourself at great length: sometimes things don’t workout In such cases you may wish to offer a slightly lower amount as a

kill fee.

Committees Keep them as far away as possible from thewriting process Anything written in committee usually ends up

being written for the committee (or rather the powerful figures

within it), not for the target audience (see false feedback loop).

COMMISSIONING

Communication Getting a message across from one person

to another Writing something down does not guarantee this (see

effective writing).

Communication theories Communication is a cated business and there are all types of theories that take intoaccount a wide range of factors influencing all those involved in theprocess, such as knowledge, context and motivation

compli-For effective writing as defined in this book, however, a basic

reader-centred model will suffice With this model, a writer sends a

message that must be read – and understood – by the target reader It

may sound simple but it has some important implications The firstthing is that you are no longer writing for yourself or your colleagues

(see false feedback loop) You can write in such a way to increase the chances of this happening (see evidence-based writing) You have a

way of judging success: ‘Did the target audience read it?’ (see

effective writing).

Competitions From time to time publications run writingcompetitions, often because they are an excellent way of finding newtalent If you want to break into these markets, watch out for themand enter Even if you do not win, it will bring your writing to theattention of an editor, and this could be the start of a mutually bene-ficial relationship

Compromise See negotiating changes.

Computers, writing on One of the great drawbacks ofcomputers is that they can take much of the pain out of writing Thisleads to two major problems The first is enticing people to write too

early (see premature expostulation) The second is that it allows

people to sit and fiddle with what they have written In such cases the

solution is to print out a copy and do your rewriting on hard copy.

This will at least allow you to have a sense of progress

Computer screens If you cannot write a sentence without

going back and fiddling with it, turn off your monitor (see free writing).

26

Concise writing I find this a puzzling concept Many peoplewho come on my courses say they want to learn how to write moreconcisely Yet these tend to be the ones who argue loudest in favour oflong and flowery words and phrases Perhaps concise writing issomething they have been told they want, but don’t actually want it

(or value it) themselves (see false feedback loop).

Conference abstracts Those with ambitions to travel and

to advance their knowledge and careers need to master the art of the

conference abstract Unlike the abstracts published alongside a

scientific paper, they stand alone, to be published in the conferenceabstract book If you are lucky, they will earn you an invitation toproduce a poster, or present a paper

Approach conference abstracts as you would any other writing task

(see process of writing) In particular research carefully what the

organizers want: this means looking carefully through all the advancematerial you can get hold of It also means looking at the material

from last year’s conference Study the structure of previous abstracts.

Look also at the topics dealt with in the past; try to find somethingthat will develop these ideas and discussions

Conference reports Those who attend conferences areoften asked by those who don’t to ‘write it up’ This sounds a straight-forward task, but isn’t The main problem is that these conferenceschurn out thousands (if not millions) of words; the writer’s task is tocut them down to about 1000 and arrange them in a way that willattract the uncommitted reader You clearly cannot cover everythingand everyone, so these reports are neither a précis nor a set of

minutes.

Avoid clinging to the order of the conference proceedings (‘In theearly afternoon we heard an excellent presentation on sentenceconstruction before moving on to the future of the paragraph after

tea ’) Avoid also using the shape of a scientific article (see IMRAD

structure) Prefer the feature article structure: from all the

informa-tion you will have collected, formulate a message and then choose toput in only the information that will support and elaborate thatmessage

• Get a good brief from the start Make sure you get detailed

informa-tion from whoever asks you to write the report (see

commis-sioning) Which publication and what kind of audience? What

CONCISE WRITING

format? Is there an example of the kind of conference report theylike (and perhaps one they don’t)?

• At the conference, just soak up the information Don’t just listen to the

proceedings, but look at notice boards, exhibitions and anythingelse that takes your fancy These could provide detail and colour tolift your report out of the mundane At the same time try to makesense of it all What’s new? What’s interesting? What would thereaders like to hear about?

• After the conference, decide on a message Lack of data is rarely the

problem; the difficulty is how to order it As with all types ofwriting, start with the basics: construct a 12 word message from

the conference, then go through the usual stages (see process of

writing).

• Don’t be afraid to leave things out This is not a shopping list but a

brief account What some might call bias is necessary selection;don’t be afraid to do it

Conferences Gatherings of the professional tribes, usually at

someone else’s expense A great way of travelling to foreign parts (see

The point is that readers have the right to assume that the viewsexpressed in an article are honestly held, and are not being expressedfor other reasons, such as an expenses-paid trip to Monte Carlo If

publications are not trusted, they lose their usefulness (see Pravda

effect) If there is any reason for anyone to suppose that bias could

take place, then it must be declared Failure to do so looks suspicious

Confusing pairs Some words are troublesome because they

sound the same as other words (see homophones); others give

trouble because they are confused with other words that sounddifferent – but not too different Here is a sample:

• affect and effect: (1) to influence, and (2) to accomplish,

• alleviate and elevate: (1) to lessen, and (2) to raise or increase,

28

• continual and continuous: (1) very often, and (2) unbroken,

• flaunt and flout: (1) to display ostentatiously, and (2) to display

contempt for (the law etc.),

• prescribe and proscribe: (1) to suggest a course of action, (2) to

forbid,

• prostrate and prostate (1) lying down, and (2) male gland.

Controversy Editors realize that there is nothing better forreadership than a good row So they welcome controversy, up to a

point (see lawyers)

Copy Journalists’ term for a piece of writing, as in ‘Where’s thebloody copy?

Copy-editors People used by book publishers (mainly) toput text into house style, correct grammar and spelling, and to pointout infelicities (such as, in this case, my failure in the first draft togive copy-editors an entry of their own) They can perform

invaluable services See also technical editors; subeditors.

Copyright This establishes the creator of a piece of originalwork and protects authors against others stealing the idea or makingmoney out of copying it, often badly There are two ways in which itaffects authors

First, you must seek permission if you want to use substantialpieces of text, charts or tables from another article The precise defi-nition of the word ‘substantial’ keeps many lawyers and their family

in luxury, so if in doubt, pass the buck swiftly to your publisher Mostpublishers ask authors to assign the copyright to them, so this task isfairly straightforward

Then there is the question of how authors, particularly thoseworking on their own, can ensure that they, and not their publisher,will make the money their brilliance deserves This has always been

difficult, and the new freedoms of the World Wide Web will make it

more so I suspect that this is one of those areas where the amount ofeffort (and loss of goodwill) is usually outweighed by the actualamount of money involved The simple answer is that, if your idea is

CONFUSING PAIRS

that good, then you should immediately get yourself an agent, who

can carry out these unpopular arguments on your behalf

Correcting the work of others We often use the word

‘corrections’ to describe the marks that other people have put overwhat we have written In fact they are usually changes, and not

corrections (see balanced feedback).

Corrections Publishing anything is a complicated business,

and mistakes are inevitable (see law of late literals) Editors clearly

have a duty to their readers to correct information that has beenproved to be wrong In some cases, this is relatively trivial: ‘Inyesterday’s obituary we said that John Brown-Green died in a caraccident in Barnes In fact it was in East Sheen.’ In other cases, such

as publishing an incorrect dose, it could be a matter of life and death

(see proofreading).

Coughing The habit of starting a piece of writing with someweak words (‘It is interesting to note that ’, ‘Some observers havenoted ’) that could be moved to the end of the sentence or even cut

out altogether These can be identified quite easily with the first six

words test However, with letters, the convention is to start with a

polite cough in the first sentence: ‘Thank you so much for your kindletter ’ or, ‘It was so nice to meet you last Saturday’

Court action Best to avoid (see lawyers; libel).

Covering letter Presentation is an important part of the

battle to impress an editor, and the covering letter offers an excellent

opportunity to make a good impression from the start In particularyou will have the opportunity to establish three things

• Who you are This comes partly from your name and title at the

bottom of the letter, but also from a range of other things – forinstance, the formal stationery on which the letter is written; thetypeface that is chosen and the way it is presented; written cues,such as, ‘our team has already published in your journal’; andeven the style (friendly, pompous, illiterate?) in which you phrase30

the letter If you are submitting to magazines and newspapers forthe first time, you may wish to enclose some cuttings of previousarticles you have had published in similar publications.

• What you are offering Avoid the formulaic ‘Enclosed please find herewith my paper Letters to the editor: a multicentre double-blind

trial.’ This is dull (most journal titles are dull) Sell your message:

‘I enclose a copy of our paper which proves for the first time thatwriting covering letters of more than 200 words increases dramat-ically the chance of being published.’ Putting the title at the top ofthe letter, as a heading, will give you the best of both worlds

• Why the editor will benefit from publishing what you have written The

final paragraph of your letter gives you an opportunity to sell Do

so gently Avoid veiled threats (‘I am a member of the disciplinarycommittee of the Royal College of Medical Communicators’),bribes (‘I hope that you will be our guest at our next congress inRio de Janeiro’) and sycophantic appeals (‘I am a regular reader ofyour excellent journal’) But you may wish to drop in the fact thatyour research gives the next step in a series of findings published

by the journal, or that it genuinely adds to the debate on animportant topic If you feel brave, try humour (‘Our finding is soimportant and your journal so well-read that they belong to oneanother’) but it can be a dangerous game to play

With most journals, the covering letter to the editor will also have anumber of formal requirements Many journals, for instance, require

all co-authors to sign Carefully read the Instructions to Authors to

see what is required

Editors of course will swear that they are never influenced by suchthings But then they would, wouldn’t they?

Crap A useful term in certain circles to describe a piece ofwriting that does not work This does not necessarily mean that thewriter is a failure, though it does suggest that he or she should go

back and do some more work (see process of writing) Do not use this term in front of the author (see balanced feedback).

Creativity In general we can favour this, but use it in the wayyou select and organize your information – and not to indulge inextravagant ways of expressing yourself

COVERING LETTER

Criteria of good writing Rarely shared and agreed (see

effective writing).

Criticism An important part of the writing process It should

be constructive, but rarely is (see balanced feedback).

Cutting things out This is inevitable But it takes up a lot oftime and you should, within reason, be producing first drafts ofroughly the right length If you find that you are regularly having tocut out large chunks of text, you might wish to re-examine the way

you write (see leaf shuffling).

CV Producing CVs involves a difficult balancing act: we need toproduce a short account of our life that will be flashy enough to sell usabove the heads of dozens, perhaps hundreds, of rivals – without layingourselves open to the shameful crime of self-promotion The importantthing to remember is that CVs are not an all-inclusive description ofour entire life and times, but a tool to get us on the shortlist

• Keep updating the information Regular updates will ensure that you

always have on hand the raw material needed to produce highquality CVs quickly They will encourage you to keep reviewing

what you have done – and what you still need to do (see goal

setting)

• Do some market research Try to see what others are currently

producing, either by asking around or, perhaps, by volunteering

to sit on a selection committee yourself Compare the CVs of thosewho have been shortlisted with those who have not, not just interms of what information they include, but also in terms of howthey are presented Don’t buck the accepted conventions: a youngdoctor of my acquaintance recently had a talented designer friend

‘modernize’ her CV; she got no interviews When she returned tothe more conventional format, the interview offers started to

return (see marketing).

• Match the CV to the job With word processors there is no excuse for

not tailoring each CV for each job Ask yourself: what are theylooking for? You may wish to give something a little more promi-nence or cut out something else; it will take only a few minutes

• Keep it factual Avoid vague terms (‘prolific author’) and keep to

the information (published papers in 23 journals, including seven32